Skip to main content
SpringerLink
Log in

Lymph Node Procedures of the Head and Neck

  • Chapter
  • First Online:
Merkel Cell Carcinoma

  • 734 Accesses

Abstract

Likely due to the increased propensity for sun exposure, the head and neck is the most common place to develop Merkel cell carcinoma (MCC). Combined with the aggressive nature of the disease and proclivity of locoregional/distant spread, the lymphatic-rich area of the head and neck makes early diagnosis and treatment of MCC in this region paramount.

Within the head and neck, MCC is often found on the most sun-exposed areas. However, a thorough oral and nasal exam is necessary to determine the presence of synchronous lesions on mucous membranes. Other cancerous lesions, including basal and squamous cell carcinoma, may also be present and should be identified.

Sentinel lymph node biopsy has become a valuable tool in the staging of head and neck MCC. A thorough preoperative discussion should be conducted with the patient regarding the logistics of the procedure and potential treatment options available.

When situated on the head or neck, excision of the primary lesion makes for a formidable challenge of reconstruction. While the primary goal is complete surgical removal of disease with negative margins, the secondary goal is to preserve the function and aesthetic of the face. Surgeons should be considerate of these fundamental tenants when developing their operative plan.

While occasionally still performed, lymphadenectomy procedures are less commonly used as a means to cure patients of locoregional disease. Studies have supported the role of adjuvant radiotherapy to local nodal beds to suppress lymphatic spread and increase disease-free survival.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Heath M, Jaimes N, Lemos B, Mostaghimi A, Wang LC, Penas PF, et al. Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features. J Am Acad Dermatol. 2008;58:375–81.

    Article  PubMed  Google Scholar 

  2. Akhtar S, Oza KK, Wright J. Merkel cell carcinoma: report of 10 cases and review of the literature. J Am Acad Dermatol. 2000;43:755–67.

    Article  PubMed  CAS  Google Scholar 

  3. Agelli M, Clegg LX. Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol. 2003;49:832–41.

    Article  PubMed  Google Scholar 

  4. Hodgson NC. Merkel cell carcinoma: changing incidence trends. J Surg Oncol. 2005;89:1–4.

    Article  PubMed  Google Scholar 

  5. Reichgelt BA, Visser O. Epidemiology and survival of Merkel cell carcinoma in the Netherlands. A population-based study of 808 cases in 1997–2007. Eur J Cancer. 2010;47(4):579–85.

    Article  PubMed  Google Scholar 

  6. Miller RW, Rabkin CS. Merkel cell carcinoma and melanoma: etiological similarities and differences. Cancer Epidemiol Biomarkers Prev. 1999;8:153–8.

    PubMed  CAS  Google Scholar 

  7. Lanoy E, Costagliola D, Engels EA. Skin cancers associated with HIV infection and solid-organ transplantation among elderly adults. Int J Cancer. 2010;26(7):1724–31.

    Google Scholar 

  8. Penn I, First MR. Merkel’s cell carcinoma in organ recipients: report of 41 cases. Transplantation. 1999;68(11):1717–21.

    Article  PubMed  CAS  Google Scholar 

  9. Feng H, Shuda M, Chang Y, Moore PS. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science. 2008;319:1096–100.

    Article  PubMed  CAS  Google Scholar 

  10. Duncavage EJ, Le BM, Wang D, Pfeifer JD. Merkel cell polyomavirus: a specific marker for Merkel cell carcinoma in histologically similar tumors. Am J Surg Pathol. 2009;33:1771–7.

    Article  PubMed  Google Scholar 

  11. Duncavage EJ, Zehnbauer BA, Pfeifer JD. Prevalence of Merkel cell polyomavirus in Merkel cell carcinoma. Mod Pathol. 2009;22:516–21.

    Article  PubMed  CAS  Google Scholar 

  12. Carter JJ, Paulson KG, Wipf GC, Miranda D, Madeleine MM, et al. Association of Merkel cell polyomavirus-specific antibodies with Merkel cell carcinoma. J Natl Cancer Inst. 2009;101:1510–22.

    Article  PubMed  CAS  Google Scholar 

  13. Gillenwater AM, Hessel AC, Morrison WH, et al. Merkel cell carcinoma of the head and neck: effect of surgical excision and radiations on recurrence and survival. Arch Otolaryngol Head Neck Surg. 2001;127:149–54.

    PubMed  CAS  Google Scholar 

  14. Brisset AE, Olsen KD, Kasperbauer JL, et al. Merkel cell carcinoma of the head and neck: a retrospective case series. Head Neck. 2002;24:982–8.

    Article  Google Scholar 

  15. Reichel OA, Mayr D, Issing WJ. Oropharyngeal metastasis of a Merkel cell carcinoma of the skin. Eur Arch Otorhinolaryngol. 2003;260:258–60.

    PubMed  Google Scholar 

  16. Sarnaik AA, Lien MH, Nghiem P, Bichakjian CK. Clinical recognition, diagnosis, and staging of Merkel cell carcinoma, and the role of the multidisciplinary team. Curr Probl Cancer. 2010;34:38–46.

    Article  PubMed  Google Scholar 

  17. National Comprehensive Cancer Network (NCCN). Merkel cell carcinoma treatment guidelines (updated annually). www.nccn.org.

  18. Schmalbach CE, Lowe L, et al. Reliability of sentinel lymph node biopsy for regional staging of head and neck Merkel cell carcinoma. Arch Otolaryngol Head Neck Surg. 2005;131:610–4.

    Article  PubMed  Google Scholar 

  19. Allen PJ, Zhang ZF, Coit DG. Surgical management of Merkel cell carcinoma. Ann Surg. 1999;229:97–105.

    Article  PubMed  CAS  Google Scholar 

  20. Goepfert H, Remmler D, et al. Merkel cell carcinoma (endocrine carcinoma of the skin) of the head and neck. Arch Otolaryngol. 1984;110:707–12.

    Article  PubMed  CAS  Google Scholar 

  21. Ames SE, Krag DN, Brady MS. Radiolocalization of the sentinel lymph node in Merkel cell carcinoma: a clinical analysis of seven cases. J Surg Oncol. 1998;67:251–4.

    Article  PubMed  CAS  Google Scholar 

  22. Alex JC. The application of sentinel node radiolocalization to solid tumors of the head and neck: a 10-year experience. Laryngoscope. 2004;114:1–19.

    Article  Google Scholar 

  23. Hitchcock CL, Bland KI, Laney RG, et al. Neuroendocrine (Merkel cell) carcinoma of the skin: its natural history, diagnosis, and treatment. Ann Surg. 1988;207:201–7.

    Article  PubMed  CAS  Google Scholar 

  24. Kokoska ER, Kokoska MS, Collins BT, et al. Early aggressive treatment of Merkel cell carcinoma improves outcome. Am J Surg. 1997;174:688–93.

    Article  PubMed  CAS  Google Scholar 

  25. Shaw JH, Rumball E. Merkel cell tumour: clinical behaviour and treatment. Br J Surg. 1991;78:138–42.

    Article  PubMed  CAS  Google Scholar 

  26. Yiengpruksawan A, Coit DG, Thaler HT, et al. Merkel cell carcinoma: prognosis and management. Arch Surg. 1991;126:1514–9.

    Article  PubMed  CAS  Google Scholar 

  27. Silva EG, Mackay B, Goepfert H, et al. Endocrine carcinoma of the skin (Merkel cell carcinoma). Pathol Annu. 1984;19:1–30.

    PubMed  Google Scholar 

  28. Hill ADK, Brady MS, Coit DG. Intraoperative ­lymphatic mapping and sentinel lymph node biopsy for Merkel cell carcinoma. Br J Surg. 1999;86:518–21.

    Article  PubMed  CAS  Google Scholar 

  29. Warner RE, Quinn MJ, et al. Management of Merkel cell carcinoma: the roles of lymphoscintigraphy, sentinel lymph node biopsy and adjuvant radiotherapy. Ann Surg Oncol. 2008;15:2509–18.

    Article  PubMed  Google Scholar 

  30. Mehrany K, Otley CC, et al. A meta-analysis of the prognostic significance of sentinel lymph node status in Merkel cell carcinoma. Dermatol Surg. 2002;28:113–7.

    Article  PubMed  Google Scholar 

  31. Gupta SG, Wang LC, et al. Sentinel lymph node biopsy for evaluation and treatment of patients with Merkel cell carcinoma. Arch Dermatol. 2006;142:685–90.

    Article  PubMed  Google Scholar 

  32. Willis AI, Ridge JA. Discordant lymphatic drainage patterns revealed by serial lymphoscintigraphy in cutaneous head and neck malignancies. Head Neck. 2007;29:979–85.

    Article  PubMed  Google Scholar 

  33. Gonzalez RJ, Padhya TA, Cherpelis BS, Prince MD, Aya-Ay ML, Sondak VK, et al. The surgical management of primary metastatic Merkel cell carcinoma. Curr Probl Cancer. 2010;34:77–96.

    Article  PubMed  Google Scholar 

  34. Shnayder Y, Weed DT, Arnold DJ, et al. Management of the neck in Merkel cell carcinoma of the head and neck: University of Miami experience. Head Neck. 2008;30:1559–65.

    Article  PubMed  Google Scholar 

  35. Lawenda BD, Thiringer JK, Foss RD, et al. Merkel cell carcinoma arising in the head and neck. Am J Clin Oncol. 2001;24:35–42.

    Article  PubMed  CAS  Google Scholar 

  36. Allen PJ, Bowne WB, Jacques DP, et al. Merkel cell carcinoma: prognosis and treatment of patients from a single institution. J Clin Oncol. 2005;23:2300–9.

    Article  PubMed  Google Scholar 

  37. Bichakjian CK, Lowe L, Loa CD, et al. Merkel cell carcinoma: critical review with guidelines for multidisciplinary management. Cancer. 2007;110:1–12.

    Article  PubMed  Google Scholar 

  38. Morrison WH, Peters LJ, Silva EG, et al. The essential role of radiation therapy in securing locoregional control of Merkel cell carcinoma. Int J Radiat Oncol Biol Phys. 1990;19:583–91.

    Article  PubMed  CAS  Google Scholar 

  39. Meeuwisen JA, Bourne RG, Kearsley JH. The importance of postoperative radiation therapy in the treatment of Merkel cell carcinoma. Int J Radiat Oncol Biol Phys. 1995;31:325–31.

    Article  Google Scholar 

  40. Suntharalingam M, Rudoltz MS, Mendenhall WM. Radiotherapy for Merkel cell carcinoma of the skin of the head and neck. Head Neck. 1995;17:96–101.

    Article  PubMed  CAS  Google Scholar 

  41. Mendenhall WM, Mendenhall CM, Mendenhall NP. Merkel cell carcinoma. Laryngoscope. 2004;114:906–10.

    Article  PubMed  Google Scholar 

  42. Veness MJ, Morgan GJ, Gebski V. Adjuvant locoregional radiotherapy as best practice in patients with Merkel cell carcinoma of the head and neck. Head Neck. 2005;27:208–16.

    Article  PubMed  Google Scholar 

  43. Lewis KG, Weinstock MA, Weaver AL, et al. Adjuvant local irradiation for Merkel cell carcinoma. Arch Dermatol. 2006;142:693–700.

    Article  PubMed  Google Scholar 

  44. Clark JR, Veness MJ, Gilbert R, et al. Merkel cell carcinoma of the head and neck: is adjuvant radiotherapy necessary? Head Neck. 2007;29:249–57.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, 2233 Post Street, 3rd Floor, San Francisco, CA, 94115, USA

    Chase M. Heaton

  2. Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, 2380 Sutter Street, 1703, San Francisco, CA, 94115, USA

    Steven J. Wang

Authors
  1. Chase M. Heaton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven J. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven J. Wang .

Editor information

Editors and Affiliations

  1. Department of Dermatology, Northwestern University, Chicago, 60611, Illinois, USA

    Murad Alam

  2. University Hospitals Case Medical Center, Department of Dermatology, Case Western Reserve University, Cleveland, 44106, Ohio, USA

    Jeremy S. Bordeaux

  3. Department of Dermatology, University of California, San Francisco, San Francisco, 94115, California, USA

    Siegrid S. Yu

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Heaton, C.M., Wang, S.J. (2013). Lymph Node Procedures of the Head and Neck. In: Alam, M., Bordeaux, J., Yu, S. (eds) Merkel Cell Carcinoma. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6608-6_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-6608-6_7

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6607-9

  • Online ISBN: 978-1-4614-6608-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation